CURRENT ISSUE - - Southern California Psychiatric Society

Southern California
PSYCHIATRIST
Volume 63, Number 7
March 2015
Newsletter of the Southern California Psychiatric Society
President’s Column
A Rainy Journal Article Review
David Fogelson, M.D.
The view from my study is drenched in rain. The down pour is heavy enough to cause rain
water to catapult over the rain gutter and come streaming onto the patio. As the shrubs and
trees drink up the rain, they seem to immediately turn a richer green, as if I was watching time
lapse photography. All this water and recent rains have me convinced that our drought must
be coming to an end. I could not be more wrong. I learned a lesson in relativity when I researched our rain totals for this winter. Downtown Los Angeles has received 6.42 inches of rain
from Oct. 1 to Feb. 22; last year’s total during that same span was 1.11 inches. The historical average during
that time is 10.16 inches. We have had six times as much rain this year as last year, leading me to think that
the drought must be over. The truth of the matter is that we have had 40% less rain this year than in an average year. Things are not always what they seem and they are constantly in flux. In the time it has taken me to
write this paragraph, the weather has gone from a rain storm to rain drops glistening in the sun!
Today, I will review a provocative article that appeared in the February issue of the American Journal of Psychiatry “Uncovering the Hidden Risk Architecture of the Schizophrenias: Confirmation in Three Independent
Genome-Wide Association Studies” by Arnedo et al. The findings in this study exemplify that things are not always what they seem. I am particularly interested in this article as the bulk of my research over the years has
focused on the genetics of schizophrenia. The genetic underpinnings of schizophrenia have been elusive.
Genome wide association studies (GWAS) have begun to uncover genomic loci that account for 25% of the heritability of schizophrenia, but this has required sequencing the genome of over 36,000 patients and 113,000 control subjects. While these are impressive numbers of research subjects, we do not expect that even larger
numbers of subjects in GWAS studies will lead to discovering the missing 75% of the heritability factors
related to schizophrenia. Arnedo
and his colleagues argue that we
In This Issue...
Letter from the Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Psychopharmacology Update 26 . . . . . . . . . . . . . . . . . . . . . . . .4
Council Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
SCPS Mentorship Program . . . . . . . . . . . . . . . . . . . . . . . . . . .10
(Continued on page 2)
March 2015
2
don’t necessarily require larger GWAS studies but rather, may analyze the data that we already possess in a
novel manner. By doing so, we will discover that much of the missing heritability has been right before our eyes.
We just have not known how to “see” it.
Arnedo and colleagues examined the GWAS data and found that single-nucleotide polymorphisms (SNPs) cluster within individuals in SNP sets. The SNP sets were in turn found to share subjects. Independent of SNP clustering they found that phenotypic data (in their study, symptoms and signs of schizophrenia) also clustered into
factors. Each factor was made up of slightly different symptom combinations of positive, negative, and disorganized symptoms. They name these factors clinical syndromes or phenotypic sets. They tested whether or not
SNP sets were consistently associated with distinct phenotypic sets. Their approach is novel because it does not
assume there is one clinical syndrome representing schizophrenia but rather that there are many subtypes associated with unique sets of SNPs. They found 8 phenotypes could be uniquely associated with networks of
SNP sets. This makes intuitive sense. We know from our clinical work that patients diagnosed as suffering from
schizophrenia are a heterogeneous group, each with a slightly different clinical presentation. This study formalizes that observation and allows us to see the genetic underpinnings of this heterogeneity. The methodology requires hundreds of patients, not tens of thousands of patients, making it practical to fund replication studies.
Arnedo and colleagues found that 42 SNP sets with greater than 70% schizophrenia risk were each unique; they
did not share subjects with one another nor did they share SNPs. This is what we would expect to find if schizophrenia was heterogeneous, not one monolithic disorder.
The next step is to replicate this study and add endophenotypes, not just symptoms, meaning brain imaging and,
neurophysiology and cognitive measures. This will allow us to see even better how the subtypes represent different pathophysiology. This in turn should drive the discovery of better treatments.
Back to Southern California and our Society. At Council we are discussing many different issues: probable “right
to die legislation,” the proposed integration of mental health and medical departments in Los Angeles County, a
well-being retreat for psychiatrists, operationalizing a residents committee, and many others. The Fellowship
and Awards Committee is in the process of nominating Distinguished Fellows for 2016 and welcome suggestions for potential candidates. The Art of Psychiatric Medicine Committee has started producing its Oral Story
Telling documentary and the interviews are underway.
A reminder that there will be an advocacy training meeting at my home the evening of March 18th. Please see
the website for more information and for instructions for signing up for the meeting. Please plan to attend the
awards and installation ceremony on Saturday, May 2nd. More details may be found on our website. The APA
annual meeting in Toronto will be May 16-20, 2015.
3
Letter from the Editor
Agility
Colleen Copelan, M.D.
I know. It’s about me and my dogs again, but I just can’t help myself.
Maggie, Lacey, and I went back to New York City for the second time, for the Second Annual Westminster Kennel Club Masters Agility Championship. We didn’t win, but we did make
the guidebook photo page and our story ran above the fold in our local Ventura County Star.
And remember, we had to be Masters just to qualify. So I’m happy.
Smart, my teacher’s border collie, won first place in the 16-inch category. (Jumpers are
sorted by height.) Tex, somebody else’s border collie, got the overall first place ribbon. No sour
grapes but border collies are so much faster than labradors.
The Westminster Masters Agility Championship was held the day before the more venerable Westminster Dog Show—the thoroughbred’s beauty contest. Miss P, a cute beagle won
Best of Show. You don’t have to be run, jump or do weaves to win a beauty contest. But again, no sour grapes.
The second biggest story was the weather. It was so cold.
It was so cold that Maggie and Lacey had to wear boots! It was so cold that I had to buy a new coat! It was
so cold they canceled our flight home!
We—my husband and I—had to extend our apartment rental and buy more theater tickets! We’re pretty agile,
too. cocopelan@aol.com.
4
SCPS held its 26th annual Psychopharmacology Update on Janury 31, 2015. The meeting was wellattended and well-received. Here are photos from the event.
Joseph Goldberg, M.D. gave a 2-hour
keynote on Bipolar Disorder.
Gerald Maguire, M.D. spoke on Pharmacogenomics.
Itai Danovitch, M.D. spoke on pharmacologic implications of marijuana.
Joel Yager, M.D. spoke on eating disorders.
Attendees listen to Dr. Maguire.
Maria Lymberis, M.D announces the
next PER event.
Psychopharmacology Update 26
5
Audio Mp3/Powerpoint Order Form
Attendee Discount - $25.00
Rationale-Based Treatment of Bipolar Disorder
Joseph F. Goldberg, M.D.
Utilization of Pharmacogenomics in Psychiatric Practice
Gerald Maguire, M.D.
Pharmacological Implications of Marijuana:
Therapeutic Agent or Target for Therapeutics?
Itai Danovitch, M.D.
Eating Disorders: An Update
Joel Yager, M.D.
Complete Set of Audio Mp3’s and Powerpoints (pdfs) - on 1 Disc
$25 Attendee / $100 Non-Attendee
To order, please go to http://www.socalpsych.org/recordings.html
Or make check payable to SCPS and mail with this form to:
SCPS, 2999 Overland Ave #208, LA, CA 90064
Name
______________________________________________________________
Address ______________________________________________________________
Email
______________________________________________________________
Advertisement
We’ve got
you covered.
For over 40 years, we have provided psychiatrists
with exceptional protection and personalized
service. We offer comprehensive insurance coverage
and superior risk management support through an
“A” rated carrier. In addition to superior protection,
our clients receive individual attention, underwriting
expertise, and, where approved by states,
premium discounts.
Endorsed by the American Psychiatric
Association, our Professional Liability
Program Provides:
• Risk Management
Hotline 24/7 should
an Emergency Arise
• Insuring Company
rated “A” (Excellent)
by A.M. Best
• Telepsychiatry, ECT
coverage & Forensic
Psychiatric Services are
included
• Many discounts,
including Claims-Free,
New Business & No
Surcharge for claims
(subject to State Approval)
• Interest-free quarterly
Payments/Credit Cards
Accepted
Visit us at apamalpractice.com or call 877.740.1777 to learn more.
LEADERS IN PSYCHIATRIC MEDICAL LIABILITY INSURANCE
6
7
Council Highlights
February 12, 2015
Erick Cheung, M.D., Secretary
The meeting was called to order with quorum by Dr. Silverman, in Dr. Fogelson’s absence,
at 7:13PM.
Minutes from the January 2015 meeting were approved by Council.
President’s Report (Dr. Heather Silverman):
Dr. Shaner was invited to provide an update regarding the DMH focus group and the proposed integration of major health departments (DMH, DPH, DHS). The Council discussed
and array of issues including:
Potential benefits: Reduction of administrative costs, better health information sharing, integration of important physical and mental health clinical services, possible improvement in residency education.
Disadvantages may include: threatened, or real, loss of funding or services for mental health related to poor administrative structuring; administrative integration may not necessarily lead to clinical
integration.
Alternative models may include: combining mental and physical health in one department, integrating mental and substance abuse treatment. Project terminology should be clarified.
Other discussion: emphasis was made on the concern that mental health services and funding
might be potentially sidelined in a consolidated system, the need to maintain (or even maximize)
funding streams for mental health services, fear of the loss of “recovery model” to the “medical model”.
Announcements:
Advocacy training occurring 3/18/15 at Dr. Fogelson’s home, contact Mindi Thelen for more details.
SCPS Installation is May 2, 2015 at Le Merigot.
Brief and initial discussion was held regarding physician assisted suicide and APA’s organizational stance
on this issue. The topic was deferred to the March Council meeting for further discussion.
Discussion was held regarding prescribing psychotropics to foster children and anticipated legislation.
Concerns were expressed regarding the potential restriction or challenges in obtaining necessary medications for this population. Support was expressed for increasing non-pharmacologic interventions to
address behavioral and psychosocial problems.
Council discussed the conceptual proposal of a “wellness workshop” or meeting. Dr. Furuta is investigating the possibility of planning such a workshop.
Council discussed a request from CPA to create a network of physicians / psychiatrists that would provide
pre-diversion services to impaired physicians. A major problem relates to mandatory waivers of confidentiality to physician notes. Council recommended publishing this request in SCPS and CPA newsletters.
Council discussed a CA legislative proposal for increasing “crisis care services” for children/adolescents.
General support was expressed for this proposal, and the matter is referred to CPA legislative and child
committees.
8
Membership Report: A motion was made to accept the membership committee’s recommendations, seconded,
and approved.
Treasurer’s Report (Dr. Duriez): A review of current financial status of the organization was presented. A motion
was made, seconded, and approved to accept the treasurer’s report. A motion was made, seconded, and approved to investigate appropriate investments.
Program Committee Report (Dr. Gales): Provided a report on the recent psychopharmacology meeting, strong
turnout at 163 attendees. Planning an ADD/ADHD program tentatively in April 2015.
The art of psychiatric medicine report (Dr. Furuta): Provided update on oral history-taking project, which is moving forward on schedule including training workshops on interviewing.
New Business: PER Foundation report (Dr. Lymberis): Provided report on upcoming 3/21/15 at 7pm (Mt Olive
Lutheran Church, 1343 Ocean Park blvd, Santa Monica, CA 90405) event supporting research for children’s mental health and PER Advocate award to former LA County Supervisor Edmund Edelman.
The meeting was adjourned by Dr. Silverman at 9:39 PM.
Ballots will be transmitted on or around
March 9, 2015. Please be sure to vote!
Advertisement
Your Talent. Our Vision. At Anthem, Inc., it’s a
powerful combination, and the foundation upon
which we’re creating greater care for our
members, greater value for our customers, and
greater health for our communities. Join us and
together we will drive the future of health care.
This is an exceptional opportunity to do innovative
work that means more to you and those we serve
at one of America's leading health benefits
companies and a Fortune Top 50 Company.
Psychiatrist
Medical Director or Medical Director Associate
Job # 98606
The Psychiatrist Medical Director or Medical
Director Associate is responsible for providing day
to day guidance, support, and leadership for the
clinical and quality activities.
The Psychiatrist Medical Director or Medical
Director Associate requires M.D; current, ABMS
Psychiatry Board certification; a current,
unrestricted medical license to practice medicine
in the any US State; 5 years of clinical practice
as a Psychiatrist; Unless expressly allowed by
state or federal law, or regulation, must be
located in a state or territory of the United States
when conducting utilization review or an appeals
consideration and cannot be located on a US
military base, vessel or any embassy located in
or outside of the US.
Anthem, Inc. is ranked as one of America’s Most
Admired Companies among health insurers by
Fortune magazine, and is a 2014 DiversityInc
magazine Top 50 Company for Diversity. To
learn more about our company please visit
us at antheminc.com/careers and search
job # 98606. EOE. M/F/Disability/Veteran.
© 2015 Anthem, Inc. All Rights Reserved.
Advocacy Training March 18, 2015. Please
contact scps2999@earthlink.net for availability.
Installation and Awards Ceremony on May 2,
2015 at Le Merigot Beach Hotel and Spa.
APA Annual Meeting in Toronto May 16-20,
2015.
APA Election Results:
Maria A. Oquendo, MD, has been
elected the new President-Elect of APA.
Among others elected to leadership positions
are Altha J. Stewart, MD, Lama Bazzi, MD,
and Gail Erlick Robinson, MD,. These results are considered public, but not official
until approved by the Board of Trustees at its
March meeting.
Advertisement
9
10
SCPS Mentorship Program
In keeping with its tradition of providing collegiality among its members, SCPS has offered an opportunity for those interested in either being a mentor or a mentee. In the
past mentors have volunteered to lend personal insight into, and answered questions
from residents and early career psychiatrists about, a career in psychiatry. Mentees
meet regularly with the mentor to develop an individual program to foster one’s clinical,
scholarly and/or research interests. Mentors may make introductions to other mentors
with research and other intellectual interests similar to the mentee’s. If you are a member interested in serving as a mentor or wanting to be paired with a mentor, please
email Earl at:
earlandrew.deguzman@med.usc.edu
or, Mindi at scps2999@earthlink.net with your particular area of interest, availability,
and contact information.
Advertisement
11
CLASSIFIED ADVERTISEMENTS
Positions Available
PSYCHIATRISTS COUNTY OF SAN BERNARDINO SOUTHERN CALIFORNIA
San Bernardino County Dept. of Behavioral Health is seeking Board Eligible/Certified adult and child psychiatrists. Openings are in several outpatient clinics, jail services and juvenile hall.
Full-time Adult Psychiatrist BE/BC staff positions range from $226,949 - $239,263/yr, with full benefit package
including medical, vision/dental, vacation, sick time, deferred compensation and retirement package.
Contract positions for BE/BC Adult Psychiatrists starting at $121.29 - $131.01/hr, Child Psychiatrists BE/BC
$136.71 - $138.71/hr. with and without medical/dental/deferred compensation and retirement.
Full-time and Contract Psychiatrists who are assigned to a Correctional Mental Health Services designated facility will receive a $5/hr. differential in addition to the base salary. Bilingual (Spanish/English) candidates
are highly desirable and receive additional compensation.
Must possess either a valid Physician’s & Surgeon’s License or Osteopathic Physician’s and Surgeon’s License issued by the State of California Medical or Osteopathic Board.
Applicants must hold U.S. citizenship or a permanent resident Visa. Please send C.V. and copy of current License to: Teresa Frausto, MD, Medical Director, 303 E. Vanderbilt Way, San Bernardino, CA 92415-0026,
(909) 388-0810, fax (909) 890-0281 or email jpringle@dbh.sbcounty.gov.
For more details, please review the announcement at www.sbcounty.gov/hr. Application can be made on-line –
apply ASAP – open until a sufficient number of applications has been received. Human Resources: (909) 3878304 - EEO/ADA
Space Available
Office for Sublet in Santa Monica - Exquisite Penthouse Psychotherapy Office: Corner office, floor-to-ceiling
windows, gorgeous views, contemporary leather and wood furniture, land-line phone and Wi-Fi. Sound
proofed, private entry and exit, large kitchen with full size refrigerator and water cooler. Furnished shared waiting room. Days available: Tuesday, Friday, Saturday, Sunday. Contact info: drlaureemoss@gmail.com, 310828-0234.
12
ALL EDITORIAL MATERIALS TO BE CONSIDERED FOR PUBLICATION IN THE NEWSLETTER MUST BE RECEIVED BY SCPS NO LATER THAN THE 5TH OF THE PRECEDING
MONTH. NO AUGUST PUBLICATION. ALL PAID ADVERTISEMENTS AND PRESS RELEASES MUST BE RECEIVED NO LATER THAN THE 5TH OF THE PRECEDING MONTH.
SCPS Officers
President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . David Fogelson, M.D.
President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Heather Silverman, M.D.
Secretary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Erick Cheung, M.D.
Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sophie Duriez, M.D.
Treasurer-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anita Red, M.D.
Councillors by Region (Terms Expiring)
Inland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ijeoma Ijeaku,M.D. (2015)
San Fernando Valley. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oscar Pakier, M.D. (2017)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Benjamin Woo, M.D. (2016)
San Gabriel Valley/Los Angeles-East. . . . . . . . . . Hanumantah Damerla, M.D. (2015)
Steven Horwitz, M.D. (2016)
Santa Barbara . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Paul Erickson, M.D. (2015)
South Bay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mary Read, M.D. (2016)
South L.A. County . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dharmesh Sheth, M.D. (2016)
Ventura . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vacant (2017)
West Los Angeles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Curley Bonds, M.D. (2017)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Marcy Borlik, M.D. (2016)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Michael Gales, M.D. (2016)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Roderick Shaner, M.D.(2015)
ECP Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Arsalan Malik, M.D. (2015)
ECP Deputy Representative . . . . . . . . . . . . . . . . . . . . . . Michelle Furuta, M.D. (2016)
MIT Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Galya Rees, M.D. (2015)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Devin Stroman, M.D. (2015)
Past Presidents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mary Ann Schaepper, M.D.
Larry Lawrence, M.D.
Steve Soldinger, M.D.
Federal Legislative Representative . . . . . . . . . . . . . . . . . . . . . . Steve Soldinger, M.D.
State Legislative Representative. . . . . . . . . . . . . . . . . . . . . . . . . . . . Mary Read, M.D.
Public Affairs Representative . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vacant
Lawrence Gross, M.D. (2017)
Larry Lawrence, M.D. (2018)
Assembly Representatives
Mary Ann Schaepper, M.D. (2016)
Desktop Publishing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mindi Thelen
CPA Officers
President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Timothy Murphy, M.D.
President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William Arroyo, M.D.
Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Catherine Moore, M.D.
Trustee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Melinda Young M.D.
Government Affairs Consultant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Randall Hagar
SCPS Newsletter
Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Colleen Copelan, M.D.
Editorial Committee
Ronald Thurston, M.D.
SCPS website address: www.socalpsych.org
© Copyright 2015 by Southern California Psychiatric Society
Southern California PSYCHIATRIST, (ISSN #10476334), is published monthly, except
August by the Southern California Psychiatric Society, 2999 Overland Ave., Suite 208,
Los Angeles, CA 90064, (310) 815-3650, FAX (310) 815-3650.
POSTMASTER: Send address changes to Southern California PSYCHIATRIST, Southern California Psychiatric Society, 2999 Overland Ave., Suite 208, Los Angeles, CA
90064.
Permission to quote or report any part of this publication must be obtained in advance from
the Editor.
Opinions expressed throughout this publication are those of the writers and do not necessarily reflect the view of the Society or the Editorial Committee as a whole.The Editor
should be informed at the time of the Submission of any article that has been submitted
to or published in another publication.
Executive Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mindi Thelen
DISCLAIMER
Advertisements in this newsletter do not represent endorsement by the Southern
California Psychiatric Society (SCPS), and contain information submitted for
advertising which has not been verified for accuracy by the SCPS.